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Incidence of Treatment for End-Stage Renal Disease Among Individuals With Diabetes in the U.S. Continues to Decline

Diabetes Care, Volume 33, number 1, January 2010 Authors: Nilka Rios, Burrows, MPH; Yanfeng Li, MPH; Linda S. Geiss, MA

End Stage Renal Disease (ESRD) (i.e. kidney failure requiring dialysis or transplantation) causes significant burden on individuals and the health care system and in 2006 reached nearly $23 billion in costs, > 6% of the Medicare budget.  

Researchers, Burrows et al, using the U.S. Renal Data Systems (USRDS), reviewed data from 1990 – 2006 to identify the incidence of individuals who had treatment initiated for ESRD where diabetes is listed as the primary cause of the renal failure.   “The researchers report that the diabetes-related ESRD incidence in the diabetes population has declined in all age-groups however less for the Hispanic population during 1997-2006. They also report that the total number of individuals who began treatment for ESRD increased from 49,868 in 1990 to 108,928 in 2006.  Of these cases, 17,727(36%) were diabetes related in 1990 and 48,215 (44%) were diabetes related in 2006.  The number of cases of diabetes-related ESRD consistently increased for all age, sex-age, and race-age groups and among Hispanics in all age-groups. 

The researchers report that the decrease in incidence suggests success in the efforts in prevention of ESRD including better glycemic control, use of ace inhibitors and early detection and treatment.   They report that “alternate explanations could be that the large and sustained new cases of diabetes since the 1990s has led to a large number of individuals who have not had diabetes long enough to develop ESRD; that the ADA revised the diagnostic criteria for diabetes lowering the fasting glucose to 126 from 140 possibly resulting  in a greater number of individuals with milder disease detected earlier in the disease process;  and that longer survival could lead to longer diabetes durations and a greater opportunity to develop ESRD.  Once these patients with new-onset, milder diseases have had diabetes long enough, it is possible that the encouraging trends in diabetes-related ESRD incidence may reverse. “

Bottom-line:  Continued surveillance of diabetes related ESRD using USRDS data will assist public health in determining if approaches to decreasing the incidence of ESRD are effective over time.  The data also demonstrates the increasing burden of this condition on individuals and the health care system as numbers continue to increase and the amount of work yet in front of us.

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